Turning Point Program Student Application Year: APPLICATIONS ACCEPTED BY MAIL ONLY Bergen Community College Turning Point Program Room L121 Pitkin Education Building 400 Paramus Road Paramus, NJ 07652 201-493-4087 turningpoint@bergen.edu ALL APPLICATIONS ARE REVIEWED BY THE ADMISSIONS COMMITTEE Revised 10/2017
Application for Admission Applicants are to complete the following pages of the Application Packet to be considered for the Turning Point Program. Once the packet is submitted and received, it will be reviewed by the Admission Committee. Applicants that are found eligible may be called for an interview with the Admission Committee and may be invited to attend a shadowing day. The interview and shadowing day process is meant to ensure the Turning Point Program is an appropriate fit for the applicant. Applications for the Fall 2018 semester are due by January 31, 2018. Please note, due to space limitations of the Program, not all students who meet the criteria for admission will be accepted. Each applicant should complete the Application Checklist as independently as possible. The applications can be typed or hand written and must include all information. Two Letters of Recommendation must be included in application packet. Each recommendation must be in a sealed envelope with signature across the seal. Applications not containing the mandatory information and documents will not be reviewed. 1. Turning Point Student Application 2. Current Photo of Applicant Application Checklist 3. Student Questionnaire to be completed by the applicant 4. Parent/Guardian Information to be completed by parent/guardian 5. Emergency Contact/Medical Information Form 6. Release/Exchange of Information Form 7. Evaluations MANDATORY conducted within five years for school purposes and/or by an outside/private provider Educational and Psychological/Behavioral evaluations must be included 8. Academic Performance Documentation most recent individualized education plan (IEP), official high school transcripts or any records from attended post-secondary program 9. Two Letters of Recommendation to be completed by a non-family member that has known the applicant for one or more years. Letters must be submitted using the Recommendation Form (pg. 17 & 18 of the application) and returned with the application packet as directed on the form. NOTE: Letters of Recommendation must be included in a sealed envelope with signature across seal. Applicant s Signature: Date: Turning Point Program 2
Application for Admissions Procedure Records submitted must support that the applicant has an Intellectual Disability in order to be considered for the Turning Point Program. The application packet is reviewed as a whole by the Admission Committee to determine if the applicant meets the eligibility requirements as well as ensure Turning Point is a good fit the applicant. If students are deemed eligible, they will be invited to take part in an interview with the Admission Committee where they will be asked to demonstrate basic literacy skills (reading and writing). Applicants may also be invited attend a shadowing day of the Program to further determine if Turning Point is an appropriate setting academically, socially, and vocationally. The Turning Point Program is a comprehensive program of study for unique learners who are highly motivated young adults whose disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills *(AAIDD definition). Applicants will have received extensive special education services in their secondary schools and would have considerable difficulty succeeding in a traditional college degree program. Applicants must have a strong desire to become an independent adult, and demonstrate sufficient emotional stability and maturity to participate successfully in the program. Please note, due to space limitations of the Program, not all students who meet the criteria for admission will be accepted. Admission is based on the following criteria: Applicants must be between the age 18-30 at the start of the program The applicant must have significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. (AAIDD definition of Intellectual Disability) The applicant must have sufficient emotional and independent stability to participate in all aspects of the program coursework and campus environment The applicant must demonstrate the ability to accept and follow reasonable rules and behave respectfully towards others. Note: The program does not have the personnel to supervise students with difficult and challenging behaviors or dispense medications. The applicant must demonstrate the desire to attend Turning Point and adhere to the policies regarding attendance and participation in the program. The applicant must have the potential to successfully achieve his/her goals with the context of the Turning Point Program s content and setting Applicant must have been identified with an intellectual disability while active in the K-12 system Please do not call about the status of your application, as we will not be able to provide this information for you over the phone. You will receive an email, phone call or letter letting you know of your acceptance or denial. *Idea 2004 requires that, when a student gradates or reaches age 21 and is no longer eligible for special education and related services, a summary of the student s academic achievement and functional performance must be provided to the student. (SOP) The summary must include recommendations on how to assist the student in meeting the student s post-secondary goals. Such summaries are required for students who graduate or turn 21 on or after July 1, 2005. Turning Point Program 3
Please complete all sections of the application. If you need assistance, it is acceptable for the applicant to receive support. We request all sections be completed in order to assist us in determining this applicant s admissibility to the program. All information is confidential and will not be shared with any outside agencies unless a written agreement is provided by the applicant. You may attach additional information and pages for writing space if needed. STUDENT INFORMATION Last Name First Name MI Home Phone Home Address Birth Date City State Zip Code Home Phone E-Mail Address Cell Phone **Your SSN is confidential and under federal law it is protected and will not be disclosed to unauthorized parties. Disclosures may be authorized for the purpose of state and federal financial aid, academic transcripts or accountability research. Student receives support from: (please check those that apply) Supplemental Security Income (SSI) Social Security Disability Insurance (SSDI) Division of Developmental Disabilities (DDD Self Directed Supports) Medical Assistance Division of Vocational Rehabilitation Services (DVRS) Special Education Services (IDEA funding) Turning Point Program 4
FAMILY INFORMATION Student lives with: both parents Mother Father Guardian(s) other Mother/Guardian: Last Name First Name MI Home Phone Address Occupation/ Employer City State Zip Code Work Phone Email Address Cell Phone Father/Guardian: Last Name First Name MI Home Phone Address Occupation/ Employer City State Zip Code Work Phone Email Address Cell Phone Siblings: Name Age EMERGENCY CONTACT INFORMATION: IN CASE OF AN EMERGENCY, PLEASE CONTACT: NAME: AT Turning Point Program 5
EDUCATION HISTORY Schools Attended (Name, City, State) Years attended Reason for Leaving Do you receive a high school diploma or equivalent? No Yes From (school) Date Please describe your academic strengths and weaknesses. What type of accommodations help you learn best? (e.g. small groups, extra time) In the following areas, please describe skills you would like to learn? Independent living: Liberal Studies (Art, Literature): Social/recreational /leisure: Employment: Have you participated in general education classes in your past school? Yes No If yes, list subjects Have you have any accommodations for your general education classes? Yes No If yes, what kind? Turning Point Program 6
EMPLOYMENT HISTORY Please complete the following. Note: prior work experience is not a requirement for admission into this program Name of Business/Employer Paid or Unpaid Job Responsibilities Reason for Leaving Amount of time at job Are you currently participating in a work experience? Is this experience paid or unpaid? Are you currently participating as a volunteer? What work experiences do you have an interest in or enjoy? TRANSPORTATION What type of transportation do you plan to utilize if you were to attend the Program? Are there any limitations, support needs or related issues to transportation? (Please list) Turning Point Program 7
MEDICAL HISTORY Please give a brief description of your medical history including any disability diagnoses that you may have: Please list any significant medical or physical conditions that may impact your participation in classroom, social, or recreational activities on campus, including severe allergies: Please list any current medications and their purpose: Note: If the applicant must take medications while on campus, he/she must be independent in administering his/her medications. Bergen Community College does not have the personnel or facility to administer medications. This is not included in any of the program or college services. Do you currently receive private therapeutic services? Physical therapy, occupational therapy, outpatient counseling/psychiatry, speech therapy, behavioral therapy? If so, please indicate which services: Are you independent in self-care such as toileting, and basic hygiene? Yes No Please provide any other medical information that you feel would be important regarding your participation in this program, please specify. Turning Point Program 8
Bergen Community College treats and regards all written documentation obtained to verify a disability and plan for appropriate services as well as all documented services and contracts with the Office of Student Support Services as confidential. However, it may be necessary for our staff to exchange some information about you with the Bergen Community College faculty and staff in order to provide you with educational opportunities and experiences on and off campus. This exchange will occur only with your written permission, as given in this document below, and with the understanding that only information necessary for the purposes of accommodation and academic progress will be communicated. Name Date I give permission to exchange information about me to the following offices/individuals checked below: School District(s) DVR Office DDD Office Admissions Office Counseling Office Course Instructors Financial Aid Office Parents/Guardians Registrar s Office Tutor Other I hereby give permission for the Turning Point Program at Bergen Community College the right to use my photograph and/or quotes and videotapes of me for public relations and/or training purposes. Student Signature Date Parent/Guardian Signature Date Turning Point Program 9
PERSONAL SUPPORT INVENTORY To be filled out by: Parent/Family/Guardian/Support person Independent Living Skills Negotiating/finding way around campus environment Ordering and purchasing from a restaurant/cafeteria/ store Handling personal affairs: laundry, light cooking, cleaning, managing personal belongings Interpersonal Skills: Ability to relate to others Asks for help, clarification, or questions Use of judgment skills in an emergency 1 (Requires complete 2 (Needs moderate 3 (Needs some 4 (Needs minimal 5 (Completely Independent) Emotional: Copes with stress Adjusts to new situations Social Skills and Communication Communicating needs in an appropriate manner Engaging in appropriate social interaction Using pay phone, cell phone, email 1 (Requires complete 2 (Needs moderate 3 (Needs some 4 (Needs minimal 5 (Completely Independent) Turning Point Program 10
Academic Skills 1 (Requires complete Handling money: counting change/bills, understanding values, using checkbook, staying within budget Math skills: Approximate Grade Levels: Addition Subtraction Multiplication Division Reading and writing skills: Approximate Grade Levels: Reading Writing Listening Comprehension 2 (Needs moderate 3 (Needs some 4 (Needs minimal 5 (Completely Independent) Computer Skills: Word processing, Internet Motivation to learn and persist on new tasks Knows and can verbalize and/or write personal information: name, address, phone, SSN, etc. Ability to follow verbal directions Ability to follow written directions Ability to keep a daily schedule with due dates and assignments Turning Point Program 11
Has applicant utilized any assistive technology? If yes, what? Please list/discuss any physical, intellectual, social or emotional conditions that may need to be considered when planning a postsecondary experience. Turning Point Program 12
STUDENT QUESTIONNAIRE This section is to be filled out by the potential student and additional pages may be included. This is an excellent opportunity to show off your writing skills, your critical thinking skills, and your creativity! Why would you like to attend the Turning Point Program at Bergen Community College? What topics are you interested in learning about in college courses? What do you want to learn that you haven t learned in high school? What type of job/career would you like to have after graduation? Turning Point Program 13
What do you enjoy doing in your free time? Any specific hobbies you enjoy? Do you spend time with friends outside of school? YES NO What do you like to do with your friends? Please list two goals you have for your future and explain how the Turning Point Program would help you achieve those goals if accepted. Turning Point Program 14
Please use this page to provide us with any additional information about yourself that you wish to share. Turning Point Program 15
Turning Point Program Recommendation Form (Applicant name) The above named individual has applied for admission to the Turning Point Program at Bergen Community College. The program serves to provide young adults with intellectual disabilities an inclusive college experience that will further their academic, vocational, social and independent living skills. Please answer the following questions to the best of your ability. If you have any further question please contact the Turning Point Program at 201-493-4087. Please Note: Letters of Recommendation must be included in a sealed envelope with signature across the seal. Your Name: Title: Address: City: State: Zip Code: Phone: Organization: Email Address: How long have you known the applicant, and in what capacity? Do you feel the applicant would benefit from the program? Yes No Why or why not? Does the applicant have any behaviors that would interfere with their ability to participate in the program? Yes No Comments: Describe the strengths that the applicant has that will make him/her a strong applicant for the Turning Point. Turning Point Program 16
Turning Point Program Recommendation Form (Applicant name) The above named individual has applied for admission to the Turning Point Program at Bergen Community College. The program serves to provide young adults with intellectual disabilities an inclusive college experience that will further their academic, vocational, social and independent living skills. Please answer the following questions to the best of your ability. If you have any further question please contact the Turning Point Program at 201-493-4087. Please Note: Letters of Recommendation must be included in a sealed envelope with signature across the seal. Your Name: Title: Address: City: State: Zip Code: Phone: Organization: Email Address: How long have you known the applicant, and in what capacity? Do you feel the applicant would benefit from the program? Yes No Why or why not? Does the applicant have any behaviors that would interfere with their ability to participate in the program? Yes No Comments: Describe the strengths that the applicant has that will make him/her a strong applicant for the Turning Point. Turning Point Program 17